Custody, care and criminality: clinical aspects of forensic psychiatric institutionalisation in late nineteenth- and early twentieth-century Ireland

Ireland experienced a rapid rise in psychiatric committals in the nineteenth and early twentieth centuries. While there have been (limited) explorations of selected aspects of the social, institutional and legislative factors underlying this phenomenon, there is a paucity of literature relating to clinical aspects. The published works in this Doctorate demonstrate that individuals committed to institutional forensic psychiatric care during the late nineteenth and early twentieth centuries (with a particular focus on women) showed evidence of social, psychiatric and medical problems. Archival case records present clear evidence of a range of medical and psychiatric disorders (including syphilis, intellectual disability, folie à plusieurs). At population level, there was significant diagnostic reclassification (from intellectual disability to mental illness) in parallel with the asylum-building of the 1800s. Other contributors to institutionalisation include the emergence of the insanity defence in Irish courts in the late 1800s and high levels of medical, psychiatric and social need outside Ireland’s system of asylum care (e.g. in workhouses), especially during the Great Famine (1845-1849). There is also evidence of therapeutic enthusiasm and institutional protectionism on the part of doctors, perpetuating Ireland’s asylum system. Key figures included Dr. William Saunders Hallaran in Cork in the early 1800s, Dr. Conolly Norman in Dublin in the early 1900s, and Professor John Dunne in Dublin in the early- to mid-1900s. Overall, individuals with mental illness and/or intellectual disability who engaged in offending behaviour in nineteenth- and early twentieth-century Ireland experienced lengthy periods of detention, high levels of mental and physical illness, and a relatively high risk of dying in the asylum, despite contemporary awareness of this problem amongst asylum managers and doctors. Archival clinical case-notes present strong evidence that medical and psychiatric need contributed substantially to this situation, alongside institutional, legislative and societal factors promoting committal

Ecological values of Hamilton urban streams (North Island, New Zealand): constraints and opportunities for restoration

Urban streams globally are characterised by degraded habitat conditions and low aquatic biodiversity, but are increasingly becoming the focus of restoration activities. We investigated habitat quality, ecological function, and fish and macroinvertebrate community composition of gully streams in Hamilton City, New Zealand, and compared these with a selection of periurban sites surrounded by rural land. A similar complement of fish species was found at urban and periurban sites, including two threatened species, with only one introduced fish widespread (Gambusia affinis). Stream macroinvertebrate community metrics indicated low ecological condition at most urban and periurban sites, but highlighted the presence of one high value urban site with a fauna dominated by sensitive taxa. Light-trapping around seepages in city gullies revealed the presence of several caddisfly species normally associated with native forest, suggesting that seepage habitats can provide important refugia for some aquatic insects in urban environments. Qualitative measures of stream habitat were not significantly different between urban and periurban sites, but urban streams had significantly lower hydraulic function and higher biogeochemical function than periurban streams. These functional differences are thought to reflect, respectively, (1) the combined effects of channel modification and stormwater hydrology, and (2) the influence of riparian vegetation providing shade and enhancing habitat in streams. Significant relationships between some macroinvertebrate community metrics and riparian vegetation buffering and bank protection suggest that riparian enhancement may have beneficial ecological outcomes in some urban streams. Other actions that may contribute to urban stream restoration goals include an integrated catchment approach to resolving fish passage issues, active reintroduction of wood to streams to enhance cover and habitat heterogeneity, and seeding of depauperate streams with native migratory fish to help initiate natural recolonisation

Guided Reflection Interventions Show No Effect on Diagnostic Accuracy in Medical Students

Background: Guided reflection interventions, in an effort to reduce diagnostic error, encourage diagnosticians to generate alternative diagnostic hypotheses and gather confirming and disconfirming evidence before making a final diagnosis. This method has been found to significantly improve diagnostic accuracy in recent studies; however, it requires a significant investment of time, and psychological theory suggests the possibility for unintended consequences owing to cognitive bias. This study compared a short and long version of a guided reflection task on improvements in diagnostic accuracy, change in diagnostic confidence, and rates of corrected diagnoses.Methods: One hundred and eighty-six fourth- and fifth-year medical students diagnosed a series of fictional clinical cases, by first impressions (control condition) or by using a short or long guided reflection process, and rated their confidence in their initial diagnostic hypothesis at intervals throughout the process. In the “short” condition, participants were asked to generate two alternatives to their initial diagnostic hypothesis; in the “long” condition, six alternatives were required.Results: The reflective intervention did not elicit more accurate final diagnoses than diagnosis based on first impressions only. Participants who completed a short version of the task performed similarly to those who completed a long version. Neither the short nor long form elicited significant changes in diagnostic confidence from the beginning to the end of the diagnostic process, nor did the conditions differ on the rate of corrected diagnoses.Conclusions: This study finds no evidence to support the use of the guided reflection method as a diagnostic aid for novice diagnosticians, who may already use an analytical approach to diagnosis and therefore derive less benefit from this intervention than their more experienced colleagues. The results indicate some support for a shorter, less demanding version of the process, and further study is now required to identify the most efficient process to recommend to doctors

The inherent jurisdiction of the Irish High Court: Interface with psychiatry

The term “inherent jurisdiction” refers to a set of default powers, usually not set out in statute, which enables a court to fulfil its roles. We discuss recently reported cases where such power has been exercised by the Irish High Court and what this means for psychiatrists in practice. These cases demonstrate that (a) the Irish High Court can be involved in decision-making where there is a lacuna in mental health legislation and a lack of mental capacity; (b) when a minor has been placed by the Court in a specialist facility in the UK and then attains the age of 18 years, decisions can be based on mental capacity but not on preventative detention on the basis of risk; (c) complexities arise when definitions of mental disorder vary between jurisdictions, especially when the Court orders involuntary detention in a case where statute would not ordinarily allow this; and (d) the appropriate route to seek decision-making for adults with mental incapacity is through Ireland's “Ward of Court” process, although, on the face of it, this seems to be contrary to the approach taken in other cases in which inherent jurisdiction was used. Overall, while it is reassuring for state health services that they can seek to approach higher courts in respect of decision-making in complex cases, some of these decisions raise important ethical questions for psychiatrists who may be asked to treat patients detained under their care who may not have a treatable mental illness as their condition falls outside of mental disorder within Irish legislation. We recommend that clear guidance is made available to psychiatrists in light of these judgments, particularly as there is likely to be a reconsideration of cases where Irish patients are placed in the UK given the UK's planned departure from the EU

The changing face of Capacity legislation in Ireland: algorithms for clinicians

Capacity legislation in Ireland is evolving. The Assisted Decision-Making (Capacity) Act 2015 has been passed into law, but its main provisions are yet to be commenced. This paper compares the law and its practical implications currently and under the new legislation. Quick reference algorithms for frontline clinicians are proposed

Dr. Harold C. Smith Fund of Ursinus College Official Prospectus, November 28, 2017

This prospectus contains investment strategy and performance for the following stocks in the managed fund: Garmin Ltd., Masimo, Micron Technology, Stoneridge and WalMart Stores, Inc

Clinical and Mucosal Immune Correlates of HIV-1 Semen Levels in Antiretroviral-Naive Men.

Background. This study was done to characterize parameters associated with semen human immunodeficiency virus (HIV)-1 ribonucleic acid (RNA) viral load (VL) variability in HIV-infected, therapy-naive men. Methods. Paired blood and semen samples were collected from 30 HIV-infected, therapy-naive men who have sex with men, and 13 participants were observed longitudinally for up to 1 year. Human immunodeficiency virus RNA, bacterial load by 16S RNA, herpesvirus (Epstein-Barr virus and cytomegalovirus [CMV]) shedding, and semen cytokines/chemokines were quantified, and semen T-cell subsets were assessed by multiparameter flow cytometry. Results. Semen HIV RNA was detected at 93% of visits, with \u3e50% of men shedding high levels of virus (defined as \u3e5000 copies/mL). In the baseline cross-sectional analysis, an increased semen HIV VL correlated with local CMV reactivation, the semen bacterial load, and semen inflammatory cytokines, particularly interleukin (IL)-8. T cells in semen were more activated than blood, and there was an increased frequency of Th17 cells and γδ-T-cells. Subsequent prospective analysis demonstrated striking interindividual variability in HIV and CMV shedding patterns, and only semen IL-8 levels and the blood VL were independently associated with semen HIV levels. Conclusions. Several clinical and immune parameters were associated with increased HIV semen levels in antiretroviral therapy-naive men, with induction of local proinflammatory cytokines potentially acting as a common pathway